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HomeMy WebLinkAboutBLDG-22-006756 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kx_Yr-E1 CITY YARMOUTH MA DATE May 23,2022 PERMIT# BLDG-22-006756 JOBSITE ADDRESS 35 OYSTER COVE RD OWNER'S NAME David Bayer G OWNER ADDRESS 35 OYSTER COVE RD SOUTH YARMOUTH MA 02664-2320 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO ❑ FIXTURES FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:outdoor fire pit INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER OF INDEMNITY❑ BOND El OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany(a.gmail.com ?%` rvc2 cco fintiai-P: PA RGEL: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =X CITY 1S (�_ - lrXG? 1..?���. .. . .-._ MA DATE $y-CIOPERMIT# (� to •• v Z v 7 JOBSITE ADDRESS ._- ,�5�� ,,,S r y s OWNER'S NAME Lac(L VO ,e/ �jQ GOWNER ADDRESS %/ r TE ,a(U /4";'/3 IFAXF:111,711,1 TYPEoTR OCCUPANCY TYPE COMMERCIAL[. EDUCATIONA IT Al 1 vfiESIDETI }IAt! A, CLEARLY NEW:j RENOVATION:] REPLACEMENT:0 Z OZNt� Mi TE�r: YES€ NO APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 ` 1 12 13 14 BOILER - ( BOOSTER I •iikt i1' �f _ til1. t CONVERSION BURNER W ( i r• MISOINE L im FIREPLACE 'imiljtociAjoimmigimmajogitseplimpup jjjaimuml ,1: am! DRYER M- -- M--w.-141-LIMIWW,M -.M.'- --M' dimm,_ NM GENERATOR i aGRILLE llaillitlimillit INFRARED HEATER ' Ijl i ir i E t i_-� 1 POOL •• _ ,._,, ,, ., _ _,. m I! I I TEST AINI:PP-__,fi41 all_ ` UNIT HEATER E ! igt UNVENTED ROOM HEATER_ i, I �; WATER HEATER ____ i OTHER il ?Mil gin 9 a a i.__ - im � { INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO II I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY.li OTHER TYPE INDEMNITY El BOND Li OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT [, SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance wit II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME /�A/ 1/. ett.� --�—' 1��,'"l� �LICENSE#4t� SIGNATURE MP 1 MGF Li JP[ JGF 0 LPGI 0 CORPORATION[Tj#[43'/G.1 PARTNERSHIP[ #[_- I LLC[�_#L_ -_1 COMPANY NAME: - _ ��� Q�L C`L°% ADDRESS �`,4 y,j3r� l CITY -'� �--- ti _'!' at, ,.._..,:..�,, STATEF#-4JztP[634l�.lwd ITELI ,3�3 9-'2-323 FAX £• __ . �� x �m, . ..---_ CELL EMAIL �` .__ __�_ _